Dual expansion anchor

ABSTRACT

A dual expansion anchor configured for use in anchoring an implanting portion to an anchor point. A dual expansion anchor can be of particular use in anchoring soft tissue to a bone. A dual expansion anchor can have an expander and an anchor body. The expander can be sized and shaped so that it causes radial expansion of a first end and a second end of the anchor body when the expander is moved to a deployment or expansion position within the anchor body. The anchor body can include features to positively retain the position of the expander when the anchor body is deployed.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No.61/543,284, filed on Oct. 4, 2011, the disclosure of which is herebyincorporated by reference in its entirety.

BACKGROUND OF THE INVENTION

Field of the Invention

The present invention relates to medical devices and procedures. Moreparticularly, the present invention relates to devices and methods forsecuring soft tissue to a rigid material such as bone.

Description of the Related Art

There are several medical procedures where a surgeon needs to attachsoft tissue such as tendons or other soft connective tissue to bone. Onecommon example is a biceps tenodesis, a surgical procedure usuallyperformed for the treatment of biceps tendonitis of the shoulder. Abiceps tenodesis may be performed as an isolated procedure, but moreoften is part of a larger shoulder surgery such as a rotator cuffrepair.

The biceps tendon connects the biceps muscle to the bone. The tendonpasses from the muscle to the shoulder joint. Patients with bicepstendon problems may have a detachment of the biceps tendon from theradial tuberosity, for example, or they may have inflammation andirritation of the biceps tendon itself. Biceps tendon problems can alsooccur in conjunction with a rotator cuff tear.

A biceps tenodesis is a procedure that cuts the normal attachment of thebiceps tendon on the shoulder socket and reattaches the tendon to thebone of the humerus (arm bone). By performing a biceps tenodesis, thepressure of the biceps attachment is taken off the cartilage rim of theshoulder socket (the labrum), and a portion of the biceps tendon can besurgically removed. Essentially a biceps tenodesis moves the attachmentof the biceps tendon to a position that is out of the way of theshoulder joint.

To perform a biceps tenodesis repair, typically a surgical procedure isused and requires the multiple steps of externalizing the tendon, whipstitching it, threading suture through a tenodesis screw, drilling thenecessary bone hole and anchor insertion via screwing it in. This is adifficult procedure arthroscopically. Systems recently brought to marketstill require multiple steps and tools

SUMMARY OF THE INVENTION

Some embodiments relate to a bone anchor. A bone anchor can include, forexample, a bone engaging member having a first proximal bone engagingportion and a second distal bone engaging portion and an expansionfeature that allows radial expansion of the first bone engaging portionand the second bone engaging portion. A bone anchor can further includean expander with a first proximal expansion portion and a second distalexpansion portion and displaceable between a first position relative tothe bone engaging member and a second position relative to the boneengaging member and a tissue capture feature. In some embodiments, thefirst expansion portion of the expander can expand the first boneengaging portion of the bone engaging member and the second expansionportion of the expander can expand the second bone engaging portion ofthe bone engaging member when the expander is in the second position.

Some embodiments relate to a bone anchor. A bone anchor can include, forexample, a bone engaging member having a first end and a second end. Thebone engaging member can include a first plurality of bone-engagingtines extending longitudinally towards the first end, a second pluralityof bone-engaging tines extending longitudinally towards the second end,and an expander having a first portion and a second portion positionedalong a longitudinal axis. In some embodiments, the expander can bepositioned between the first plurality of bone engaging tines when theexpander is in a first position. In some embodiments, the expander ispositioned between the first plurality of bone engaging tines andbetween the second plurality of bone engaging tines when the expander isin a second position. In some embodiments, the expander can expand boththe first set of tines and the second set of tines outward upon movementof the expander relative to the bone-engaging member from a firstposition to a second position.

Some embodiments relate to a bone anchor. A bone anchor can include, forexample, a bone engaging member having a first proximal bone engagingportion and a second distal bone engaging portion and an expansionfeature that allows radial expansion of the first bone engaging portionand the second bone engaging portion. Some embodiments of a bone anchorcan include a two piece expander having a first expansion member with afirst expansion portion and a second expansion member with a secondexpansion portion. In some embodiments, the first expansion member andthe second expansion member can be displaceable between first positionsrelative to the bone engaging member and second positions relative tothe bone engaging member. Some embodiments of a bone anchor can includea tissue capture feature. In some embodiments of a bone anchor, thefirst expansion portion of the first expansion member can expand thefirst bone engaging portion of the bone engaging member and the secondexpansion portion of the second expansion member can expand the secondbone engaging portion of the bone engaging member when first and secondexpansion members are in their second positions.

Some embodiments relate to a method of attaching soft tissue to bone.The method can include, for example, inserting tissue and an anchorhaving a first expandable bone engaging portion at a first end of theanchor and a second expandable bone engaging portion at a second end ofthe anchor into the bone, expanding the first expandable bone engagingportion of the anchor to engage the bone, and expanding the secondexpandable bone engaging portion of the anchor to engage the bone.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 depicts a perspective view of one embodiment of a split dualexpansion anchor in an undeployed or unexpanded state.

FIG. 2 depicts a perspective view of one embodiment of a split dualexpansion anchor in a deployed or expanded state.

FIG. 3 depicts a cut-away view of one embodiment of a split dualexpansion anchor in an undeployed or unexpanded state.

FIG. 4 depicts a perspective view of one embodiment of a tined dualexpansion anchor in an undeployed or unexpanded state.

FIG. 5 depicts a perspective view of one embodiment of a tined dualexpansion anchor in a deployed or expanded state.

FIG. 6 depicts a cut-away view of one embodiment of a tined dualexpansion anchor in an undeployed or unexpanded state.

FIG. 7 depicts a perspective view of one embodiment of an expander.

FIG. 7A depicts side views of several embodiments of a distal end of anexpander.

FIG. 7B depicts a perspective view of one embodiment of a distal end ofan expander.

FIG. 8 depicts a perspective view of one embodiment of a single pieceexpander.

FIG. 8A depicts a cut-away view of one embodiment single piece expanderdeploying a tined dual expansion anchor.

FIG. 9 depicts a perspective view of one embodiment of a two pieceexpander.

FIG. 9A depicts a cut-away view of one embodiment of a two pieceexpander deploying a tined dual expansion anchor.

FIG. 10 depicts and exploded perspective view of one embodiment of aninserter tool.

FIG. 10A depicts and exploded perspective view of one embodiment of aninserter tool configured for use with a two piece expander.

FIG. 11 is a perspective view of one embodiment of an inner rod.

FIG. 12 is a perspective view of one embodiment of an outer rod.

FIG. 12A is a perspective view of one embodiment of an outer rodconfigured for use with a two piece expander.

FIG. 13A is a side view of one embodiment of a portion of a handle body.

FIG. 13B is a perspective view of one embodiment of a portion of ahandle body.

FIG. 14 is a perspective view of one embodiment of a threaded actuatorshaft.

FIG. 15 is a perspective view of one embodiment of a deployment knob.

FIG. 16 depicts a side view of one embodiment of an inserter with anattached anchor.

FIG. 17 depicts a side view of one embodiment of an inserter with anattached anchor.

FIG. 18 depicts an exploded view of one embodiment of an inserter andanchor.

FIG. 19 depicts a bicipital groove and surrounding bone of the shoulderand biceps.

FIG. 20 depicts a bicipital groove and surrounding bone of the shoulderand biceps.

FIG. 21 depicts a tendon held in a hole by an anchor.

FIG. 22 depicts the insertion of a tendon and anchor into a hole.

FIG. 23 depicts the side view of a deployed anchor securing a tendon ina hole.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

In the following detailed description, reference is made to theaccompanying drawings, which form a part hereof. In the drawings,similar symbols typically identify similar components, unless contextdictates otherwise. The illustrative embodiments described in thedetailed description, drawings, and claims are not meant to be limiting.Other embodiments may be utilized, and other changes may be made,without departing from the spirit or scope of the subject matterpresented here. It will be readily understood that the aspects of thepresent disclosure, as generally described herein, and illustrated inthe Figures, can be arranged, substituted, combined, and designed in awide variety of different configurations, all of which are explicitlycontemplated and make part of this disclosure.

Some embodiments disclosed herein relate generally to anchors for use inanchoring tissue or objects in a body. More specifically, someembodiments disclosed herein relate generally to anchors for use inanchoring soft tissue to bone in a body. Some embodiments disclosedherein relate generally to anchors for use in anchoring sutures to abone in a body. Also some elements relate to individual components andsubcomponents of the systems described herein, as well as methods ofmaking and using the same. Some embodiments additionally relate to kitsand components used in connection with the anchor. Although thefollowing embodiments refer to the use of an anchor in anchoring tissue,a person of skill in the art will recognize that an anchor can be usedto anchor any range of items within a body.

An exemplary dual expansion anchor can include features configured forretention of the desired tissue and features configured for affixing theanchor to the desired anchor point. FIG. 1 depicts a perspective view ofone embodiment of an unexpanded dual expansion anchor 100 comprising ananchor body 110 and an expander 180. An anchor has a distal end 102 anda proximal end 104. The anchor 100 depicted in FIG. 1 has a radius ofr1. An anchor can have a variety of dimensions. In some embodiments, forexample, an anchor can have a length of 5 mm, 10 mm, 17 mm, 20 mm, 30mm, 50 mm, or any other desired length. In some embodiments, forexample, an anchor can have a diameter of 1 mm, 5 mm, 6 mm, 10 mm, 20mm, or any other desired diameter.

The anchor body 110 has a first end 112 and a second end 114. In someembodiments, the first end 112 of the anchor body 110 is configured forplacement into an anchor location. In some embodiments, the first end112 of the anchor body 110 is configured for placement into a hole in abone. In some embodiments, the second end 114 of the anchor body 110 islikewise configured for placement into an anchor location, or into ahole in a bone. In some embodiments, the anchor 100 is placed in thehole in the bone so that the second end 114 is in closer proximity tothe entrance hole into the bone than the first end 112.

An anchor 100 can be inserted into an anchor point with an insertiontool. In some embodiments, the second end 114 of the anchor body 110 isconfigured for interaction with a portion of the insertion tool tothereby allow placement of the anchor 100 at the anchor point. In someembodiments, the second end 114 of the anchor body 110 can be configuredto abut portions of the insertion tool. The abutting interaction betweenthe anchor body 110 and the insertion tool can facilitate a transfer offorces between the insertion tool and the anchor body 114, whichtransfer of forces can facilitate anchor insertion and/or result indeployment or expansion of the anchor 100.

The anchor body 110 depicted in FIG. 1 has an axial bore 116. The axialbore 116 can extend partially or entirely through the anchor body 110.In some embodiments, the axial bore 116 can be a first axial borepartially extending along the length of the anchor body 110 and a secondaxial bore partially extending along the length of the anchor body 110.The axial bore 116 depicted in FIG. 1 extends the entire length of theanchor body 110.

The axial bore 116 can be sized and dimensioned to receive the expander180. The expander 180 depicted in FIG. 1 is partially disposed withinthe axial bore 116 of the anchor body 110. The size and dimensions ofthe axial bore 116 will be discussed at greater length below.

The anchor body 110 depicted in FIG. 1 has an expansion slot 118 andteeth (or ridges) 120(a), 120(b). The expansion slot 118 allows theexpansion of the anchor body 110 when the expander 180 is movedlongitudinally in a direction from the first end 112 towards the secondend 114. When the anchor 100 is placed within a hole in a bone, thelongitudinal displacement of the expander 180 towards the second end 114of the anchor body 110 results in the radial expansion of the anchorbody 110. In some embodiments, the anchor body can be sized anddimensioned relative to the hole in which the anchor 100 is placed, sothat the radial expansion of the anchor body resulting from thelongitudinal displacement of the expander 180 towards the second end 114causes the teeth 120(a), 120(b) to engage with bone surrounding the holein which the anchor 100 is positioned. In some embodiments, the teeth120(a), 120(b) are designed to prevent the anchor 100 from displacingout of the bone. In some embodiments, the teeth 120(a), 120(b) aredesigned to stabilize the anchor 100 in the bone. In some embodiments,the teeth 120(a), 120(b) are designed to hold the anchored tissue inproximity to the bone. In some embodiments, the teeth 120(a), 120(b) aredesigned to perform a combination of these and other functions.

In some embodiments, the teeth 120(a), 120(b) may penetrate the bone,the teeth 120(a), 120(b) may partially penetrate the bone, the teeth120(a), 120(b) may form depressions in the bone, or the teeth 120(a),120(b) may deform to fit to the bone.

In some embodiments, all of the teeth 120(a), 120(b) on the anchor body110 are similarly sized and dimensioned. As depicted in FIG. 1, ananchor body 110 may also have two or more types of teeth 120(a), 120(b).Specifically, as depicted in FIG. 1, and anchor body may have a firstset of teeth 120(a) located proximate to the first end 112 of the anchorbody 110 and a second set of teeth 120(b) located proximate to thesecond end 114 of the anchor body 110.

As depicted in FIG. 1, teeth 120(a), 120(b) can have a range of sizesand shapes. A first set of teeth 120(a) can be sized and shaped toparticularly resist movement in one direction. A first set of teeth120(a), as depicted in FIG. 1, sized and shaped to particularly resistmovement in one direction can be asymmetrical. A second set of teeth120(b) can be sized and shaped to equally resist movement in alldirections. A second set of teeth 120(b), sized and shaped to equallyresist movement in all directions can be symmetrical.

FIG. 2 depicts a perspective view of the same embodiment of the dualexpansion anchor 100 comprising an anchor body 110 and an expander 180depicted in FIG. 1. As also depicted in FIG. 1, the body 110 of theanchor 100 depicted in FIG. 2 has a first end 112, a second end 114, anaxial bore 116, an expansion slot 118, and teeth 120(a), 120(b). Asdepicted in FIG. 2, the expander 180 is completely positioned within theaxial bore 116 of the anchor body 110. With the expander 180 positionedcompletely within the axial bore 116 of the anchor body 110, the anchor100 has a new radius r2. The expansion of the anchor body 110 caused bythe new positioning of the expander 180 results in radius r2 beinglarger than radius r1 of the anchor 100 depicted in FIG. 1.Additionally, while FIG. 1 depicts an anchor 100 defined by a singleradius r1, a person of skill in the art will recognize that a pluralityof non-constant radii define some embodiments of an anchor 100. Thus, anexpanded anchor 100 may have uniform or non-uniform radial expansionbetween a first end 112 and a second end 114.

The anchor 100 can have a variety of expanded dimensions. In someembodiments, for example, radius r2 is constant across the length of theanchor 100. In some embodiments, radius r2 varies across the length ofthe anchor 100. As depicted in FIG. 2, in some embodiments, radius r2increases as the longitudinal distance to the first end 112 of theanchor 100 decreases.

FIG. 3 depicts a perspective cut-away view of the same embodiment of thedual expansion anchor 100 comprising an anchor body 110. The body 110 ofthe anchor 100 depicted in FIG. 3 has a first end 112, a second end 114,an axial bore 116, an expansion slot (not shown), and teeth 120(a),120(b). An axial bore 116 has a longitudinal axis 122 and can comprise avariety of shapes and sizes. In some embodiments, an axial bore may havea single shape and constant diameter throughout the length of the anchorbody 110. In some embodiments, and as depicted in FIG. 3, the shape andsize of the axial bore 116 may vary along the length of the anchor body110. A person of skill in the art will recognize that variations in theshape and size of the axial bore 116 can be used in connection withvariations in the size and shape of the expander (not shown) to achievedesired expansion of the anchor body 110, to achieve desired placementof the expander (not shown) within the anchor body 110, and tofacilitate and/or prevent certain movements of the expander (not shown)within the anchor body 110.

As depicted in FIG. 3, and axial bore 116 can comprise portions that areparallel to the longitudinal axis 122 of the axial bore 116,perpendicular to the longitudinal axis 122 of the axial bore 116, orangled relative to the longitudinal axis 122 of the axial bore 116. Theaxial bore 116 can comprise a sloped portion 124. As depicted in FIG. 3,the sloped portion 124 can be located proximate to the first end 112 ofthe anchor body 110. The sloped portion 124 can be configured to providea cam surface for the expander (not shown) to facilitate movement of theexpander (not shown) into the axial bore 116 and to thereby facilitateincreasing of the radius of the anchor body 110 from radius r1 to radiusr2.

An axial bore 116 can include a first stop 126. As depicted in FIG. 3, afirst stop 126 is a wall non-parallel, and in some embodiments, forexample, perpendicular to the longitudinal axis 122 of the anchor body110. As depicted in FIG. 3, the first stop 126 can be configured toprovide an engageable surface to interact with portions of the expander(not shown) and thereby prevent the retraction of the expander (notshown) once the expander (not shown) has advanced past a designatedpoint. Advantageously, prevention of the retraction of the expander (notshown) enables permanent placement of an anchor 100 in bone.

A first stop can be located a desired distance from the first end so asto achieve a desired degree of spreading of the first end 112 of theanchor body 110. In some embodiments, the first stop 126 can be locatedso that the first end 112 of the anchor body 110 achieves an expandedradius of approximately 40 millimeters, 20 millimeters, 10 millimeters,5 millimeters, 2 millimeters, 1 millimeter, or any other desireddiameter.

An axial bore 116 can include a second stop 128. As depicted in FIG. 3,a second stop 128 is a wall perpendicular to the longitudinal axis 122of the anchor body 110. The second stop 128 can be configured to providean engageable surface to interact with portions of the expander (notshown) and thereby prevent the retraction of the expander (not shown)once the expander (not shown) has advanced past a designated point.Advantageously, prevention of the retraction of the expander (not shown)enables the permanent placement of an anchor 100 in bone.

A second stop 128 can be located a desired distance from the first end412 so as to achieve a desired degree of spreading of the second end 114of the anchor body 110. In some embodiments, the second stop 128 can belocated so that the second end 112 of the anchor body 110 achieves anexpanded radius of approximately 40 millimeters, 20 millimeters, 10millimeters, 7.2 millimeters, 5 millimeters, 2 millimeters, 1millimeter, or any other desired diameter.

An axial bore 116 can include a third stop 128. As depicted in FIG. 3, athird stop 130 can be a wall perpendicular to the longitudinal axis 122of the anchor body 110. As depicted in FIG. 3, the third stop 130 can beconfigured to provide an engageable surface to interact with portions ofthe expander (not shown) and thereby prevent the advancement of theexpander (not shown) past a designated point. Advantageously, preventionof advancement of the expander (not shown) past a designated pointallows consistent expansion of the anchor body 110 and prevents failureof the anchor 100 placement due to over penetration of the expander (notshown) into the anchor body 110.

FIG. 4 depicts a perspective view of one embodiment of an unexpandeddual expansion anchor 400 comprising an anchor body 410 and an expander480. The anchor has a distal end 402 and a proximal end 404.

The anchor body 410 has a first end 412 and a second end 414. In someembodiments, the first end 412 of the anchor body 410 is configured forplacement into a hole in a bone. In some embodiments, the anchor 400 isplaced in the hole in the bone so that the second end 414 is in closerproximity to the entrance hole into the bone than the first end 412. Theanchor 400 depicted in FIG. 4 has a radius at the first end 412 of r4and a radius at the second end 414 of r5. In some embodiments r4 and r5are the same. In some embodiments, r4 and r5 are different.

Anchor 400 can be inserted into an anchor point with an insertion tool.In some embodiments, the second end 414 of the anchor body 410 isconfigured for interaction with a portion of the insertion tool tothereby allow placement of the anchor 400 at the anchor point. In someembodiments, the second end 414 of the anchor body 410 can be configuredto abut portions of the insertion tool. The abutting interaction betweenthe anchor body 410 and the insertion tool can facilitate a transfer offorces between the insertion tool and the anchor body 414, whichtransfer of forces can facilitate anchor insertion and/or result indeployment or expansion of the anchor 400.

The anchor body 410 depicted in FIG. 4 has an axial bore 416. The axialbore 416 can extend partially or entirely through the anchor body 410.In some embodiments, the axial bore 416 can be a first axial borepartially extending along the length of the anchor body 410 and a secondaxial bore partially extending along the length of the anchor body 410.The axial bore 416 depicted in FIG. 4 extends the entire length of theanchor body 410.

The axial bore 416 can be sized and dimensioned to receive the expander480. The expander 480 depicted in FIG. 4 is partially disposed withinthe axial bore 416 of the anchor body 410.

The anchor body 410 depicted in FIG. 4 has plurality of first tines 418extending from a position proximal to the second end 414 of the anchorbody 410 to the first end 412 of the anchor body 410. Each of the firsttines 418 is internally defined by the axial bore 416 and radiallydefined by a plurality of first expansion slots 420. An anchor body caninclude any desired number of first tines 418 and first expansion slots420, including 10 or less, 5 or less, 4 or less, or two first tines 418and first expansion slots 420. The anchor body 410 depicted in FIG. 4has four first tines 418 and four first expansion slots 420.

The first tines 418 and first expansion slots 420 can be positioned atany desired radial position around the anchor body 410. In someembodiments, the first tines 418 and first expansion slots 420 can bepositioned at regular intervals around the anchor body 410. In someembodiments, the first tines 418 and first expansion slots 420 can beirregularly positioned around the anchor body 410. FIG. 4 depicts anembodiment of an anchor body 410 in which the first tines 418 and firstexpansion slots 420 are equiangularly positioned around the anchor body410.

Different embodiments of an anchor body 410 can additionally includefirst tines 418 and first expansion slots 420 of different lengths. Insome embodiments, the first tines 418 and first expansion slots 420 ofan anchor body 410 can have equal lengths. In some embodiments the firsttines 418 and first expansion slots 420 may have different lengths. Insome embodiments, the first tines 418 and first expansion slots 420 canbe configured to have different lengths in that some of the first tines418 may extend further from the second end 414 of the anchor body 410toward the first end 412 of the anchor body 410 than other of the firsttines 418. In some embodiments, the first tines 418 and first expansionslots 420 can have different lengths in that some of the first expansionslots 420 can extend further from the first end 412 of the anchor body410 toward the second end 414 of the anchor body 410 than others of thefirst expansion slots 420. FIG. 4 depicts and embodiment of an anchorbody 410 in which the first tines 418 and first expansion slots 420 haveequal lengths.

The anchor body 410 depicted in FIG. 4 has plurality of second tines 422extending from a position proximal to the first end 412 of the anchorbody 410 toward the second end 414 of the anchor body 410. Each of thesecond tines 422 is internally defined by the axial bore 416 andradially defined by a plurality of second expansion slots 424. An anchorbody can include any desired number of second tines 422 and secondexpansion slots 424, including 10 or less, 5 or less, 4 or less, or twosecond tines 422 and second expansion slots 424. The anchor body 410depicted in FIG. 4 has four second tines 422 and four second expansionslots 424.

The second tines 422 and second expansion slots 424 can be positioned atany desired radial position around the anchor body 410. In someembodiments, the second tines 422 and second expansion slots 424 can bepositioned at regular intervals around the anchor body 410. In someembodiments, the second tines 422 and second expansion slots 424 can beirregularly positioned around the anchor body 410. FIG. 4 depicts anembodiment of an anchor body 410 in which the second tines 422 andsecond expansion slots 424 are equiangularly positioned around theanchor body 410.

Different embodiments of an anchor body 410 can additionally includesecond tines 422 and second expansion slots 424 of different lengths. Insome embodiments, the second tines 422 and second expansion slots 424 ofan anchor body 410 can have equal lengths. In some embodiments thesecond tines 422 and second expansion slots 424 may have differentlengths. In some embodiments, the second tines 422 and second expansionslots 424 can be configured to have different lengths in that some ofthe second tines 422 may extend further from the first end 414 of theanchor body 410 toward the second end 414 of the anchor body 410 thanother of the second tines 422. In some embodiments, the second tines 422and second expansion slots 424 can have different lengths in that someof the second expansion slots 424 can extend further from the second end414 of the anchor body 410 toward the first end 412 of the anchor body410 than others of the second expansion slots 424. FIG. 4 depicts andembodiment of an anchor body 410 in which the second tines 422 andsecond expansion slots 424 have equal lengths.

Some embodiments of an anchor body 410 can have a first set of tines 418and a second set of tines 422 of equal length. Some embodiments of ananchor body 410 can have a first set of tines 418 and a second set oftines 422 of different lengths. FIG. 4 depicts one embodiment of ananchor body 410 in which the first set of tines 418 is longer than thesecond set of tines 422.

Some embodiments of an anchor body 410 can have first expansion slots420 and second expansion slots 424 of equal length. Some embodiments ofan anchor body 410 can have first expansion slots 420 and secondexpansion slots 424 of different lengths. FIG. 4 depicts one embodimentof an anchor body 410 in which the first expansion slots 420 are longerthan the second expansion slots 424.

The first tines 418 and first expansion slots 420 and the second tines422 and second expansion slots 424 allow the expansion of the anchorbody 410 when the expander 480 is moved longitudinally in a directionfrom the first end 412 towards the second end 414 of the anchor body.When the anchor 400 is placed within a hole in a bone, the longitudinaldisplacement of the expander 480 towards the second end 414 of theanchor body 410 results in the radial expansion of the anchor body 410,and specifically results in the radial expansion of the first tines 418and first expansion slots 420 located at the first end 412 of the anchorbody and of the second tines 422 and second expansion slots 424 locatedat the second end 414 of the anchor body 410. In some embodiments, theanchor body 410 can be sized and dimensioned relative to the hole inwhich the anchor 100 is placed, so that the radial expansion of theanchor body resulting from the longitudinal displacement of the expander480 towards the second end 414 causes the first tines 418 and the secondtines 422 to engage with bone surrounding the hole in which the anchor400 is positioned. In some embodiments, the engagement of the bone bythe first tines 418 and the second tines 422 can be facilitated by teeth428 located on some or all of the first tines 418 and/or the secondtines 422. FIG. 4 depicts one embodiment of an anchor body 410 in whichteeth 428 are located on all of the first tines 418 and the second tines422. In some embodiments, the teeth (or ridges) 428 are designed toprevent the anchor 400 from displacing out of the bone. In someembodiments, the teeth 428 are designed to stabilize the anchor 400 inthe bone. In some embodiments, the teeth 428 are designed to hold theanchored tissue in proximity to the bone. In some embodiments, the teeth428 are designed to perform a combination of these and other functions.

In some embodiments, the teeth 428 may penetrate the bone, the teeth 428may partially penetrate the bone, the teeth 428 may form depressions inthe bone, or the teeth 428 may deform to fit to the bone.

In some embodiments, all of the teeth 428 on the anchor body 410 aresimilarly sized and dimensioned. An anchor body 410 may also have two ormore types of teeth 428. Specifically, an anchor body 410 may have afirst set of teeth located proximate to the first end 412 of the anchorbody 410 on some or all of the first tines 418, and a second set ofteeth located proximate to the second end 414 of the anchor body 410 onsome or all of the second tines 422.

FIG. 5 depicts a perspective view of one embodiment of the dualexpansion anchor 400 comprising an anchor body 410 and an expander 480.The body 410 of the anchor 400 depicted in FIG. 5 has a first end 412, asecond end 414, an axial bore 416, first tines 418, first expansionslots 420, second tines 422, second expansion slots 424, and teeth 428.As depicted in FIG. 5, the expander 480 is completely positioned withinthe axial bore 416 of the anchor body 410. With the expander 480positioned completely within the axial bore 416 of the anchor body 410,the first end 412 of the anchor body 410 has a new radius r6 and thesecond end 414 of the anchor body 410 has a new radius r7. The expansionof the anchor body 410 caused by the new positioning of the expander 480results in radius r6 at the first end 412 of the anchor body 410 beinglarger than radius r4 at the first end 412 of the anchor body 410 asdepicted in FIG. 4, and in radius r7 at the second end 414 of the anchorbody 410 being larger than radius r5 at the second end 414 of the anchorbody 410 as depicted in FIG. 4. In some embodiments r6 and r7 are thesame. In some embodiments r6 and r7 are different. Additionally, whileFIGS. 4 and 5 depict an anchor 400 defined respectively by two radii r4,r5 or r6, r7, a person of skill in the art will recognize that aplurality of constant or non-constant radii can define some embodimentsof an anchor 100. Thus, an expanded anchor 100 may have uniform ornon-uniform radial expansion between a first end 112 and a second end114.

FIG. 6 depicts a perspective cut-away view of the same embodiment of thedual expansion anchor 400 comprising an anchor body 410 configured foruse with an expander (not shown). The body 410 of the anchor 400depicted in FIG. 6 has a first end 412, a second end 414, an axial bore416, first tines 418 and first expansion slots 420, second tines 422 andsecond expansion slots 424. An axial bore 416 has a longitudinal axis430 and can comprise a variety of shapes and sizes. In some embodiments,an axial bore may have a single shape and constant diameter throughoutthe length of the anchor body 410. In some embodiments, and as depictedin FIG. 6, the shape and size of the axial bore 416 may vary along thelength of the anchor body 410. A person of skill in the art willrecognize that variations in the shape and size of the axial bore 416can be used in connection with variations in the size and shape of theexpander (not shown) to achieve desired expansion of the anchor body410, to achieve desired placement of the expander (not shown) within theanchor body 410, and to facilitate and/or prevent certain movements ofthe expander (not shown) within the anchor body 410.

As depicted in FIG. 6, and axial bore 416 can comprise portions that areparallel to the longitudinal axis 430 of the axial bore 416,perpendicular to the longitudinal axis 430 of the axial bore 416, orangled relative to the longitudinal axis 430 of the axial bore 416. Theaxial bore 416 can comprise a first sloped portion 432. The first slopedportion 432 can be located proximate to the first end 412 of the anchorbody 410, or as depicted in FIG. 6, separated from the first end 412 ofthe anchor body 410 by a parallel portion 438, parallel to thelongitudinal axis 430 of the axial bore 416. The first sloped portion432 can be configured to provide a cam surface for the expander (notshown) to facilitate movement of the expander (not shown) into the axialbore 416 and to thereby facilitate expansion of the radius of the firstend 412 of the anchor body 410 from radius r4 to radius r6.

The axial bore 416 can include a first stop 434. As depicted in FIG. 6,a first stop 434 is a wall non-parallel to the longitudinal axis 430 ofthe anchor body 410. As depicted in FIG. 6, the first stop 434 can beconfigured to provide an engageable surface to interact with portions ofthe expander (not shown) and thereby prevent the expander (not shown)from retracting once the expander (not shown) has advanced past adesignated point. Advantageously, prevention of the retraction of theexpander (not shown) enables the permanent placement of an anchor 400 inbone.

A first stop can be located a desired distance from the first end 412 soas to achieve a desired degree of spreading of the first end 412 of theanchor body 410. In some embodiments, the first stop 434 can be locatedso that the first end 412 of the anchor body 410 achieves an expandedradius of approximately 40 millimeters, 20 millimeters, 10 millimeters,5 millimeters, 2 millimeters, 1 millimeter, or any other desireddiameter.

The axial bore 416 can comprise a second sloped portion 436. As depictedin FIG. 6, the second sloped portion 436 can be located proximate to thesecond end 414 of the anchor body 410. The second sloped portion 436 canbe configured to provide a cam surface for the expander (not shown) tofacilitate movement of the expander (not shown) down the axial bore 416and to thereby facilitate expansion of the radius of the second end 414of the anchor body 410 from radius r5 to radius r7. In some embodiments,the second end 414 of the anchor body 410 achieves an expanded radius ofapproximately 40 millimeters, 20 millimeters, 10 millimeters, 7.2millimeters, 5 millimeters, 2 millimeters, 1 millimeter, or any otherdesired diameter.

An anchor can be used with a variety of expanders. FIG. 7 depicts oneembodiment of an expander 700 comprising an expansion member 702 havinga first end 710 and a second end 712. An expansion member 702 can haveone or more features configured to cause expansion of an anchor bodywhen the expander 700 is longitudinally displaced into the anchor body.The expander 700 depicted in FIG. 7 has a spreading head 714 having aradius r8 and located proximate to the first end 710 of the expansionmember 702. The spreading head 714 can be manufactured to any desiredsize and shape. As depicted in FIG. 7, spreading head 714 can comprise aconical frustum having a base 716 located at the first end 710 of theexpander. A person of skill in the art will recognize that the shape andsize of the head 714 will affect the ultimate degree and shape ofexpansion of the anchor body, as well as the requisite forces tolongitudinally displace the expander 700 within the anchor body.

In some embodiments, an expansion member 702 can include a shaft 718having a diameter r9. As depicted in FIG. 7, shaft 718 can extendlongitudinally from the spreading head 714 to the second end 712 of theexpansion member 702. Shaft 718 can have a variety of sizes and shapes.The shaft 718 depicted in FIG. 7 is a conical shaft. In someembodiments, the shaft 718 can have a diameter r9 configured to fitwithin the axial bore of an anchor body without causing expansion of theanchor body. Thus, in some embodiments, expander 700 can benon-expandingly disposed within the axial bore of the anchor body whenthe shaft 718 is located in the axial bore and features of the expansionmember 702 configured for expanding the anchor body are positioned so asto not cause expansion of the anchor body.

In some embodiments, and as depicted in FIG. 7, the shaft 718 cancomprise a caming surface 720. In some embodiments, caming surface 720can, for example, facilitate placement of the expander 700 in an axialbore of an anchor, or facilitate the expansion of the anchor body.

In some embodiments, an expander 700 can include features to facilitateapplication of forces to the expander 700 to affect deployment of theanchor. In some embodiments, an expander 700 can comprise a threadedhole in the second end 712 configured for threading engagement with athreaded portion of the insertion tool. In some embodiments of an anchorin which the anchor is deployed or expanded by the proximal movement ofthe expander 700 relative to the anchor, the anchor body can abut with aportion of the insertion tool so as to prevent movement of the anchorbody relative to the insertion tool. The expander 700 can be connectedto a portion of the insertion tool that is relatively moveable ascompared to the portion of the insertion tool against which the anchorbody abuts. In some embodiments, the abutting interaction of the anchorbody and the insertion tool, and the connection of the expander 700 to arelatively moveable portion of the insertion tool can allow thelongitudinal displacement of the expander from a first, undeployed,unexpanded position proximate to the distal end of the anchor toward theproximate end of the anchor and to a second, deployed, expandedposition.

An expander can include features configured for engaging with andcapturing material to be secured to the bone, such as, for example,tissue or a suture. These features can be located on a variety ofportions of the expansion member 702, including, for example, the head714, shaft 718, or any other feature configured for expansion. FIG. 7Adepicts several embodiments of features configured for engaging withmaterial to be secured to the bone, such as, for example, tissue or asuture, mounted on the base of the head of the expansion member. In someembodiments, an expander 750 can comprise a head 752 having a base 754.In some embodiments, the expander 750 can further include a penetratingmember 756 extending from the base 754 of the spreading head 752. Thepenetrating member 756 can comprise a variety of sizes and shapes. Asdepicted in FIG. 7A, the penetrating member 756 comprises a featurehaving a triangular cross-section, such as, for example, a featurecomprising a cone, a triangular pyramid, a square pyramid, or arectangular pyramid. The penetrating member 756 can be configured fordeforming the material to be secured to the bone, or for piercing a holeinto or through the material to be secured to the bone.

In some embodiments, the expander 750 can include a first hole 760 and asecond hole 762. Holes 760, 762 can comprise a range of sizes andshapes, and can be configured for allowing threading of the material tobe secured to the bone or a securement feature, such as, for example, asuture, through the holes 766, 768. As also depicted in FIG. 7A, in someembodiments of the expander 750, a suture 757 can pass through the firsthole 760 and the second hole 762 to form a loop 759, which, incombination with base 754 defines an encircled area 761 through which atendon or other material to be secured to the bone can be passed. Atendon, or other material to be secured to the bone can be passedthrough the encircled area 761 and the ends of the suture 757 can betensioned to constrict the loop 759 and thereby secure the material tobe secured to the bone in the loop 759 and against the base 754. Thesuture 757 can then be secured to prevent loosening of the suture 757and release of the tendon or other material to be secured to the bone.

In some embodiments, the expander 750 can further include a loop member764 extending from the base 754 of the spreading head 722. The loopmember 764 can comprise a variety of sizes and shapes. As depicted inFIG. 7A, the loop member 764 can comprise an elongated torus. The loopmember 764 as depicted in FIG. 7A can be configured for allowingthreading of the material to be secured to the bone or a securementfeature, such as, for example, a suture, through the loop member 764.

In some embodiments, the expander 750 can further include a retentionpenetrating member comprising a penetrating element 766 and a shaftelement 768 extending from the base 754 of the spreading head 752. Theretention penetrating member can comprise a variety of sizes and shapes.As depicted in FIG. 7A, the retention penetrating member comprises apenetrating element 766 having a triangular cross-section, such as, forexample, a feature comprising a cone, a triangular pyramid, a squarepyramid, or a rectangular pyramid. As depicted in FIG. 7A, the largersize the penetrating element 766 as compared to the shaft element 768can create a retention penetrating member capable of facilitatingpenetration of the material to be secured to the bone and hindering theretraction of the retention penetrating member from the material to besecured to the bone after penetration.

In some embodiments, the expander 750 can further include a plurality ofpenetrating members 770 extending from the base 754 of the spreadinghead 752. The penetrating members 770 can comprise a variety of sizesand shapes. As depicted in FIG. 7A, the penetrating members 770comprises features having a triangular cross-section, such as, forexample, a feature comprising a cone, a triangular pyramid, a squarepyramid, or a rectangular pyramid. In some embodiments, the penetratingmembers 770 can be each configured to create punctuate contact, linearcontact, or any other type of desired contact with the material to besecured. In embodiments in which the penetrating members 770 areconfigured for punctuate contact, each of the penetrating members 770can be configured to extend to a point. In embodiments in which thepenetrating members 770 are configured for linear contact, each of thepenetrating members may linearly stretch across base 754 of thespreading head 752 and extend to a linear edge. The penetrating members770 can be configured for deforming the material to be secured to thebone, or for piercing a hole into or through the material to be securedto the bone.

In some embodiments, the expander 750 can comprise a first hole 760 anda second hole 762, both extending through the spreading head 752 of theexpander 750, a suture 757 passing through the first hole 760 and thesecond hole 762, and a stirrup 774 extending from the base 754 of thespreading head 752 of the expander 750. The stirrup 772 can comprise afirst prong 774 and a second prong 776. In some embodiments, the stirrup772 can be configured to facilitate the retention of material forsecuring to a bone between the first prong 774 and the second prong 776.The stirrup 772, and the first and second prongs 774, 776 can comprise avariety of shapes and sizes, and can be made from a variety ofmaterials.

The stirrup 772 can be configured for different degrees of movementrelative to the anchor. In some embodiments, the stirrup 772 can beconfigured to partially fit within the anchor when the anchor isdeployed, and in some embodiments, the stirrup 772 may be wholly outsideof the anchor when the anchor is deployed. In some embodiments, thestirrup 772 can be static and in some embodiments, the stirrup 772 canbe dynamic. In some specific embodiments, the first and second prongs774, 776 can be static and/or dynamic relative to each other.

In some embodiments, the stirrup 772 can further comprise a shelf 778.The shelf 778 can extend between the first and second prongs 774, 776.In some embodiments, the shelf 778 can be configured to facilitate inbending of the material to be secured to the bone, and canadvantageously prevent the material from moving relative to the shelf778 while securing the material to the bone.

The shelf 778 can comprise a variety of shapes and sizes. In someembodiments, the shelf 778 can have a rectangular cross-section, atriangular cross-section, a trapezoidal cross-section, or have any otherdesired cross-sectional shape.

In some embodiments, the expander 750 can comprise a first hole 780extending through the spreading head 752 of the expander 750. The firsthole 780 can comprise a variety of shapes and sizes, and can be locatedin a variety of positions on the spreading head 752. As depicted, thefirst hole 780 can extend axially through the spreader head 752.

In some embodiments, the expander 750 can further comprise a suture 757extending through the first hole 780. In some embodiments, the suture757 can be formed into a loop 782 and can be manipulated into a knot784. In some embodiments, the knot 784 can be performed before aprocedure using the expander 750, and in some embodiments, the knot 784can be formed during the procedure. In some embodiments, the knot 784can be configured to maintain a constant size of the loop 782, and insome embodiments, the knot 784 can be configured to allow the loop 782to change size. In some embodiments, the loop 782 can be configured toreceive and retain the material that is to be secured to the bone.Advantageously, in some embodiments, the size of the suture 757 and thesize of the knot 784 can prevent the loop 782 of the suture 757 frommoving through the first hole 780 of the expander 750.

In some embodiments, the expander 750 can comprise a stirrup 772comprising a first prong 774 and a second prong 776, a first hole 780,and a spike 786. The spike 786 can be configured to retain material thatis positioned between the first and second prongs 774, 776. In someembodiments, the spike 786 can be configured to retain the materialpositioned between the first and second prongs 774, 776 by piercing thatmaterial.

The spike 786 can comprise a variety of shapes and sizes and can be madefrom a variety of materials. In some embodiments, the spike can be sizedand shaped to be positionable via the first hole 780 between the firstprong 774 and the second prong 776.

In some embodiments, the expander can comprise a combination of theabove disclosed features configured for engaging with and capturingmaterial to be secured to the bone. Thus, in some embodiments, anexpander may include, for example, one or several penetrating membersand a suture or loop member. A person skilled in the art will recognizethat the present disclosure contemplates a variety of differentcombination of features configured for engaging with and capturingmaterial to be secured to the bone, and is not limited to the specificembodiments outlined above.

FIG. 7B depicts one such hybrid embodiment of an expander includingmultiple features configured for engaging with and capturing material tobe secured to the bone. As depicted in FIG. 7B, expander 750 b comprisesa head 752 b having a base 754 b. The expander 750 b further includes aplurality of penetrating members 796 b extending from the base 754 b ofthe spreading head 752 b. As seen in FIG. 7B, these penetrating members796 b can comprise a variety of shapes and dimensions. As further seenin FIG. 7B, base 754 b further comprises a first hole 766 b and a secondhole 768 b configured to receive a suture to form suture loop 763 b. Atendon, or other material to be secured to the bone can be passedthrough the suture loop 763 b and over penetrating member 796 b.Further, tension of the suture loop 763 b increases the force with whichthe secured material contacts the penetrating members 796 b, and therebyfurther secures the material.

FIG. 8 depicts one embodiment of a single piece expander 800 comprisingand expansion member 802 having a first end 810 and a second end 812.The expansion member 802 further comprises a spreading head 814 having aradius r10 and having a base 816, a first shaft portion 818 having aradius r11, an spreading shoulder 820 having a radius r12, and a secondshaft portion 822 having a radius r13. The spreading head 814 depictedin FIG. 8 comprises a conical frustum having a base at the first end 810of the single piece expander 800. The base 816 of the spreading head 814depicted in FIG. 8, is radially elevated above the first shaft portion818, above the spreading shoulder 820, and above the second shaftportion 822, in that the radius r10 of the base 816 of the spreadinghead 814 is larger than the radius r11 of the first shaft portion 818,larger than the radius r12 of the spreading shoulder 820, and largerthan the radius r13 of the second shaft portion 822. The spreading head814 can comprise a variety of sizes and shapes and a variety of relativesizes according to application requirements for an anchor.

The expansion member 802 depicted in FIG. 8 comprises a spreadingshoulder located between the first end 810 and the second end 812 of thesingle piece expander 800. However, in other embodiments, the spreadingshoulder 820 can be located in other positions on the single pieceexpander 800, including, at the second end 812 of the single pieceexpander 800. The spreading shoulder 820 depicted in FIG. 8 is radiallyelevated above the first shaft portion 818 and above the second shaftportion 822 in that the radius r12 of the spreading should 820 is largerthan the radius r11 of the first shaft portion 818 and larger than theradius 813 of the second shaft portion 822. The spreading shoulder 822can comprise a variety of sizes and shapes and a variety of relativesizes according to application requirements for an anchor. In someembodiments, the spreading shoulder 822 can be radially smaller than,radially equal to, or radially larger than the base 816 of the spreadinghead 814, than the first shaft portion 818, or than the second shaftportion 822 Likewise, the shapes and dimensions of the other features ofthe single piece expander can be varied to achieve desired results.

FIG. 8A depicts a perspective cut-away view of an anchor 850 comprisingan anchor body 852 and an expander 800 in an expanded or deployedconfiguration.

The expander depicted in FIG. 8A comprises an expansion member 802having a first end 810 and a second end 812. The expansion member 802further comprises a spreading head 814 having a base 816 located at thefirst end 810. The expansion member additionally comprises a camingsurface 820 located proximate to the second end 812 of the expansionmember 802 and between the first end 810 of the expansion member 802 andthe second end 812 of the expansion member 802.

The anchor body 852 depicted in FIG. 8A comprises a first end 854, asecond end 856, an axial bore 858, first tines 860 and first expansionslots 862, second tines 864 and second expansion slots (not shown). Theaxial bore 858 of the anchor body 852 depicted in FIG. 8A also has afirst stop 868 and a caming abutment 870.

As depicted in FIG. 8A, the expander 800 is wholly positioned within theaxial bore 858 of the anchor body 850. Specifically, the expander 800 ispositioned within the axial bore 858 of the anchor body 850 such thatthe first stop 868 prevents movement of the expander 800 towards thefirst end 854 of the anchor body 850 by abuttingly engaging with thebase 816 of the spreading head 814 of the expander 800.

As depicted in FIG. 8A, the spreading head 814 and other portions of theexpander 800 expandingly engage with portions of the axial bore todeploy or expand the anchor body 850.

FIG. 9 depicts one embodiment of a two piece expander 900 comprising afirst expansion member 902 and a second expansion member 904. In someembodiments, a two piece expander 900 can include features to facilitateapplication of forces to the expander 900 to affect deployment of theanchor. In some embodiments of an anchor in which the anchor isdeployed, or expanded, by the movement of the expander 900 relative tothe anchor, the anchor body can abut with a portion of the insertiontool so as to prevent movement of the anchor body relative to theinsertion tool. The pieces of the expander 900 can be connected to oneor multiple portions of the insertion tool that are relatively moveableas compared to the portion of the insertion tool against which theanchor body abuts. In some embodiments, the abutting interaction of theanchor body and the insertion tool, and the connection to the pieces ofthe expander 900 allow the relatively moveable portion of the insertiontool to longitudinally displace the expander pieces from a first,undeployed, unexpanded position to a second, deployed, expandedposition.

The first expansion member has a first end 910 and a second end 912. Thefirst expansion member 902 has a first spreading head 914 having a base916 defined by a radius r14, and a first shaft portion 918 defined by aradius r15. The first spreading head 914 depicted in FIG. 9 comprises aconical frustum having a base 916 at the first end 910 of the firstexpansion member 902 of the double piece expander 900. The base 916 ofthe first spreading head 914 depicted in FIG. 9, is radially elevatedabove the first shaft portion 918 in that the radius r14 of the base 916of the first spreading head 914 is larger than the radius r15 of thefirst shaft portion 918. The first spreading head 914 can comprise avariety of sizes and shapes and a variety of relative sizes according toapplication requirements for an anchor.

The second expansion member 904 has a first end 920 and a second end922. The second expansion member 904 has a second spreading head 924having a base 926 defined by a radius r16, and a second shaft portion928 defined by a radius r17. The second spreading head 924 depicted inFIG. 9 comprises a conical frustum having a base 926 at the first end920 of the second expansion member 904 of the double piece expander 900.The base 926 of the second spreading head 924 depicted in FIG. 9, isradially elevated above the second shaft portion 928 in that the radiusr16 of the base 926 of the second spreading head 924 is larger than theradius r17 of the second shaft portion 928. The second spreading head924 can comprise a variety of sizes and shapes and a variety of relativesizes according to application requirements for an anchor. The first andsecond spreading heads 914, 924 can comprise a variety of sizes andshapes and a variety of relative sizes according to applicationrequirements for an anchor. In some embodiments, the base 916 of thefirst spreading head 914 can be radially smaller than, radially equalto, or radially larger than the base 926 of the second spreading head924. Similarly, the relative sizes of the first shaft portion 918 andthe second shaft portion 928 can vary with respect to each other andwith respect to the first and second spreading heads 914, 924.

In some embodiments of a double piece expander 900, the second expansionmember can comprise a thru-hole 930. The thru-hole can be sized andshaped to allow a portion of the insertion tool configured forattachment to the first expansion member 902 to pass through the secondexpansion member 904.

In some additional embodiments, the second end 922 of the secondexpansion member 904 can be configured for abutting contact with aportion of an insertion tool. In some embodiments, the portion of theinsertion tool can be configured to allow movement of the secondexpansion member 904 relative to the anchor body.

FIG. 9A depicts a perspective cut-away view of an anchor 950 in anexpanded or deployed configuration comprising an anchor body 952 and adouble piece expander 900.

The double piece expander 900 depicted in FIG. 9A comprises a firstexpansion member 902 and a second expansion member 904. The firstexpansion member 902 has a first end 910 and a second end 912 andcomprises a first spreading head 914 having a base 916 located at thefirst end 910. The second expansion member 904 has a first end 920 and asecond end 922 and comprises a second spreading head 924 having a base926 located at the first end 920.

The anchor body 952 depicted in FIG. 9A comprises a first end 954, asecond end 956, an axial bore 958, first tines 960 and first expansionslots 962, second tines 964 and second expansion slots (not shown). Theaxial bore 958 of the anchor body 952 depicted in FIG. 9A also has afirst stop 968 and a second stop 970.

As depicted in FIG. 9A, the expander 900 is wholly positioned within theaxial bore 958 of the anchor body 950. Specifically, the expander 900 ispositioned within the axial bore 958 of the anchor body 950 such thatthe first stop 968 prevents movement of first expansion member 902towards the first end 954 of the anchor body 950 by abuttingly engagingwith the base 916 of the first spreading head 914 of the first expansionmember 902. The second expansion member 904 of the expander 900 ispositioned within the axial bore 958 of the anchor body 950 such thatthe second stop 970 prevents movement of second expansion member 904towards the second end 956 of the anchor body 950 by abuttingly engagingwith the second spreading head 924 of the second expansion member 904.As additionally depicted in FIG. 9A, the first expansion member 902 isnot in contact with second expansion member 904. However, a person ofskill in the art will recognize that in some embodiments, a firstexpansion member 902 may be in contact with a second expansion member904.

As depicted in FIG. 9A, the first spreading head 914 and the secondspreading head 924 expandingly engage with portions of the axial bore todeploy or expand the first tines 960 and first expansion slots 962located at the first end 954 of the anchor body 950 and the second tines964 and second expansion slots 966 located at the second end 956 of theanchor body 950 respectively.

The above described dual expansion anchor can be made from a variety ofmaterials, including, natural, or manmade materials. The dual expansionanchor can be made of metal, plastic, polymer, composite, or othermaterials. In some embodiments, the anchor is made of a biocompatiblepolymer, plastic, or metal. Other embodiments include a tissue captureanchor entirely or in part of a non-metallic substance that isbiocompatible. Biocompatible materials such as poly ether ketone (PEK),polyether ether ketone (PEEK), polyetherimide (ULTEM), ultrahighmolecular weight polyethylene (UHMPE), polyphenylene, or some otherengineering polymer materials known to those of skill in the art may beused. A non-metallic anchor system may provide certain advantages suchas, for example, eliminating MRI artifacts.

FIG. 10 depicts individual components of one embodiment of an insertertool. An inserter tool comprises a range of features configured to allowthe inserter tool to insert an anchor and then deployingly interact withthe anchor. One embodiment of an inserter tool may be configured for usewith a specific anchor configuration, or with a specific spreaderconfiguration. FIG. 10 depicts an embodiment of an inserter configuredfor use with a single piece expander. The inserter tool comprises aninner rod or tube 1100, an outer tube 1200, a handle body 1300, athreaded actuator shaft 1400, and a deployment knob 1500. In someembodiments, the inserter 1000 is coupled to the anchor duringmanufacturing. In a preferred embodiment, the inserter tool isdisposable.

The inserter tool 1000 is designed to insert and manipulate an anchorsuch as the anchor described in FIGS. 1 through 6. In some embodiments,the anchor is manufactured to be attached to an inserter tool beforepackaging. In other embodiments, the tissue capture anchor is coupled tothe inserter tool prior to insertion. In a basic configuration, theinserter tool is assembled as follows: the inserter tool 1000 isconfigured such that the inner rod 1100 is disposed within the outertube 1200. The outer tube is configured to fit against the proximal endof the anchor. The inner rod 1100 extends through outer tube 1200 and isconfigured to attach to the expander via threading on both the proximalhole in the expander and threading on the distal end of the inner rod1100. The proximal end of the outer tube 1200 is connected to a handle1300 and the inner rod 1100 extends through the proximal end of theouter tube 1200 and screws into the threaded actuator shaft 1400. Theactuator shaft 1400 extends just past the proximal end of the handle1300 where it is configured to secure with a deployment knob 1500.

The individual components of the inserter tool are further described indetail below.

FIG. 10A depicts an embodiment of an inserter configured for use with atwo piece expander Like the inserter tool 1000 depicted in FIG. 10,inserter tool 1000 a comprises an inner rod or tube 1100 a, an outertube 1200 a, a handle body 1300 a, a threaded actuator shaft 1400 a, anda deployment knob 1500 a. In some embodiments, the inner rod or tube1100 a, the outer tube 1200 a, the handle body 1300 a, the threadedactuator shaft 1400 a, and the deployment knob 1500 a of inserter tool1000 a can fit together as described in relation to those features ofFIG. 10. In some embodiments, some or all of the inner rod or tube 1100a, the outer tube 1200 a, the handle body 1300 a, the threaded actuatorshaft 1400 a, and the deployment knob 1500 a of inserter tool 1000 a caninclude additional features configured to facilitate use with a twopiece expander. These differences can include, for example, additionalfeatures located on the outer tube 1200 a, or on any other feature ofthe inserter tool 100 a. Additional features of the outer tube 1200 awill be discussed in greater detail below.

FIG. 11 shows a perspective view of an embodiment of the inner rod 1100.In some embodiments, the inner rod is an inner tube. The inner rodcomprises a distal end configured to secure to the expander, a proximalend which is configured to interact with the other components of theinserter, for instance the actuator shaft 1400. The inner rod 1100 isconfigured that a proximal end 1120 is advanced through the outer tube1200 and into the handle 1300 where it is further secured within theactuator shaft 1400 via threading. The distal end 1105 of the inner rod1100 is configured to be advanced through the central hole in the anchorbody and then secured to the expander until the anchor is fully deployedand the inner rod 1100 is separated from the anchor. In someembodiments, the distal end 1106 can comprise features configured toengage with the expander, such as, for example, threads 1110. The body1125 of the inner rod 1100 is configured for sliding positioning withinouter tube 1200.

The inner rod 1100 extends through the central hole in the anchor bodybefore coupling with the expander. In one embodiment, the inner rod 1100couples with the expander through threads on the end of the inner rod1100 and within the proximal end of the expander. In other embodiments,the inner rod 1100 may couple to the expander through other securingmechanisms such as adhesives, welding or frictional fit.

FIG. 12 shows an embodiment of the outer tube 1200. The outer tube 1200is attached at its proximal end 1205 to the distal end of handle viathreading 1225. The distal end 1210 of the outer tube 1200 is configuredsuch that the inner rod is drawn into the outer tube 1200 and throughopening 1220 in the distal end 1210 of outer tube 1200 where it issecured to the expander. When the inner tube is advanced far enough thatthe expander locks into place or cannot advance anymore, the outer tube1200 distal surface is surface-to-surface with the proximal surface ofthe anchor body. When the inner rod withdraws further into the outertube upon the continued rotation of the deployment knob and advancementof the actuator shaft, the inner rod strips the threading from theexpander and the inserter tool detaches from the anchor.

FIG. 12A shows an embodiment of the outer tube 1200 a configured for usewith a two piece expander. The outer tube 1200 a is attached at itsproximal end 1205 a to the distal end of handle via threading 1225 a.The distal end 1210 a of the outer tube 1200 a is configured such thatthe inner rod is drawn into the outer tube 1200 a and through opening1220 a of the distal end 1210 a of outer tube 1200 a where it is securedto the expander. In some embodiments of an outer tube 1200 a configuredfor use with a two piece expander, the distal end 1210 a of the outertube comprises a first abutment 1212 a. In some embodiments, the firstabutment 1212 a is configured for abutting engagement with the secondend 114, 414 of a dual expansion anchor 100, 400.

In some embodiments, the distal end 1210 a of the outer tube 1200 acomprises a first base 1260 a and a first elevated abutment 1262 a. Insome embodiments, the first base 1260 is sized and dimensioned to fitwithin portions of the axial bore 116, 416 proximate to the second end114, 414 of anchor 100, 400. The first base 1260 a can be, for example,sized and shaped to slidably enter portions of the axial bore 116, 416proximate to the second end 114, 414 of the dual expansion anchor 100,400 when the dual expansion anchor 100, 400 is in its deployed orexpanded configuration, or, alternatively, to slidably enter portions ofthe axial bore 116, 416 proximate to the second end 114, 414 of the dualexpansion anchor 100, 400 when the dual expansion anchor 100, 400 is inits undeployed or unexpanded configuration. In some embodiments, thefirst elevated abutment 1262 a of the outer tube 1200 a is configuredfor abutting engagement with the second end 922 of the second expansionmember 904.

In some embodiments, the distal end 1210 a of the outer tube 1200 acomprises a second base 1270 a and a second elevated abutment 1272 a. Insome embodiments, the second base 1270 a is sized and dimensioned to fitwithin portions of the axial bore 116, 416 proximate to the second end114, 414 of anchor 100, 400. In some embodiments, second base 1270 a isconfigured to slidingly extend through a thru-hole in the secondexpansion member 904. In some embodiments, the second base 1270 a can besized and configured to extend through the second expansion member 904.In some embodiments, the second base 1270 a terminates at a point withinthe axial bore 116, 416 of the anchor 100, 400 where the second elevatedabutment 1272 a abuts the second end 912 of the first expansion member902 when the dual expansion anchor is in its deployed or expandedconfiguration.

In some embodiments, the features of the distal end 1210 a of the outertube 1200 a are configured to facilitate deployment of a dual expansionanchor 100, 400 with a two piece expander 900. In some embodiments, adual expansion anchor 100, 400 can be positioned on the distal end 1210of the outer tube 1200 a of an inserter tool 1000 a. Specifically, insome embodiments, the second expansion member 904 of a dual expansionanchor 100, 400 can abut the first elevated abutment 1262 a. In someembodiments, the second base 1270 a and the inner tube 1100 a can extendthrough a thru-hole in the second expansion member 904 of a dualexpansion anchor 900. In some embodiments, a second end 114, 414 of theanchor body 110, 410 can contact the second expansion member 904 of thetwo piece expander 900 and the first end 112, 412 of the dual expansionanchor 100, 400 can contact the first expansion member 902 of the twopiece expander 900. In some embodiments the first expansion member 902of the two piece expander 900 can be affixed to the inner tube 1100 a.When the inner tube 1100 a is longitudinally displaced to expand/deploythe anchor 100, 400, the inner tube 1100 a applies a force to the firstexpansion member 902 of the two piece expander 900 while the firstelevated abutment 1262 a applies a reactionary force to the secondexpansion member 904 of the two piece expander 900. The application ofthese forces can displace the first and second expansion members 902,904 of the two piece expander 900 until both the first and secondexpansion members 902, 904 of the two piece expander 900 are in theirdeployed position. More specifically, the first expansion member 902 ofthe two piece expander 900 can displace under applied forces until thefirst expansion member 902 of the two piece expander 900 contacts thesecond elevated abutment 1272 a. Additionally, the second expansionmember 902 of the two piece expander 900 can displace under the appliedforces until second end 114, 414 of the anchor body 110, 410 contactsthe first abutment 1212 a of the distal end 1210 a of the outer tube1200 a. In some embodiments, the second elevated abutment 1272 a can bepositioned relative to the first elevated abutment 1262 a, and the dualexpansion anchor 100, 400 can be designed such that the first expansionmember 902 of the two piece expander 900 only contacts the secondelevated abutment 1272 a after the second end 114, 414 of the anchorbody 110, 410 contacts the first abutment 1212 a of distal end 1210 a ofthe outer tube 1200 a. After both the first and second expansion members902, 904 of the two piece expander 900 reach their deployed/expandedpositions, the inner tube 1100 a is separated from the first expansionmember 902 of the two piece expander 900, and the connection between theinserter tool 1000 a and the anchor 100, 400 is terminated.

FIGS. 13A and 13B show embodiments of a handle body 1300. A handle body1300 can comprise a handle piece 1302 and a lid piece 1304. FIG. 13A isa side view of a lid piece 1304 of the handle body 1300. The proximalend of the handle 1300 is configured to receive the deployment knob viathe ridges 1330 which hold the knob secure. The actuator shaft is housedwithin the handle body 1300. A set of flat brackets or braces 1310secure the actuator shaft within the handle 1300. The distal end of thehandle 1300 is configured to receive the outer tube via threads atopening 1350. The outer tube is permanently affixed to the handle 1300at its distal end.

FIG. 13B depicts a perspective view of one embodiment of the handleportion 1302 of a handle 1300. Handle portion 1302 includes a threadedhole for threading engagement with threading 1225 of the outer tube1200. Handle portion 1302 depicted in FIG. 13B further includes bracereceiving openings 1312. Handle portion 1302 additionally includes flatsurfaces 1315.

FIG. 14 depicts the threaded actuator shaft 1400. The actuator shaft1400 is comprised of a distal end 1405 comprising a threaded hole 1410which is configured to receive the inner rod 1100, a second threadedportion 1425 on the body of the shaft configured to advance the innerrod 1100, and a proximal end 1420 configured to secure within thedeployment knob 1500. The threading 1425 of the actuator 1400 has twoflat areas 1430, one on each side, where there is no threading. Theseflat areas 1430 fit within the flat surfaces 1315 of the handle 1300such that the actuator 1400 cannot rotate within the handle.

The body of the actuator shaft 1400 is configured with threading 1425 topermit the shaft 1400 to advance the inner tube 1100. The body of theactuator shaft 1400 is not perfectly round, but rather is oval shapedwith flat sides 1430 that are fit into the handle body 1300 in such away that the actuator shaft 1400 cannot itself rotate when thedeployment knob 1500 is turned and the shaft 1400 advances via knob1500. Thus, the threads do not go all the way around the shaft butrather flatten out on the flattened sides of the shaft. The actuatorshaft is configured as a coaxial system. That is, the expander, innertube 1100 and actuator 1400 are configured to operate as one piece. Theflat surfaces 1315 in the handle make the actuator shaft 1400 stay onplane such that the actuator shaft 1400 itself cannot rotate within thehandle 1300. The proximal end of the inner tube 1100 couples with thedistal end of the actuator shaft 1400 via threading.

Moving to FIG. 15, a deployment knob 1500 is shown. The deployment knob1500 comprises a central hole 1510 which is configured with threading1505, and a groove 1530 configured to be received by a correspondingridge 1330 of the handle 1300. The threading 1505 in the central hole1510 is configured to receive the actuator shaft 1400. The deploymentknob 1500 is configured to advance, relative to the deployment knob1500, the inner rod 1100 via the actuator shaft 1400. The actuator shaft1400 is joined at its proximal end to the distal end of the deploymentknob 1500 via threading 1505 in the central hole 1510. The actuatorshaft 1400 is attached to the inner rod 1100 by way of the proximal endof the inner rod 1100 advancing into the distal end of the actuatorshaft via threading so that when the deployment knob 1500 is rotated,the mechanism of the shaft 1400 advances the inner rod 1100 proximallysuch that the expander is then advanced into the anchor body to expandthe anchor body into bone and secure the anchor.

In one embodiment, the deployment knob 1500 is threaded 1505 to receivethe actuator shaft via the groove 1530 of knob 1500 fitting with theproximal end ridge 1330 of the handle body 1300 As the deployment handleis turned, the actuator shaft 1400 is advanced in a proximal directionuntil the anchor body is deployed and locked into place.

FIG. 16 shows one embodiment of a dual expansion anchor 100 coupled tothe inserter tool 1000 and FIG. 17 shows one embodiment of a dualexpansion anchor 400 coupled to the inserter tool 1000. The anchorscomprise the anchor body 110, 410 and the expander 180, 480. Expander180 depicted in FIG. 16 includes a penetrating member 756 for securingthe anchored material. Expander 480 as depicted in FIG. 17 includes asuture 761 passing through holes 766, 768 in the expander 480 andforming a loop 763 for securing the anchored material. A person of skillin the art will recognize that any of the above disclosed, or otherfeatures configured for engaging with and capturing material to besecured to the bone can be used in connection with a dual expansionanchor 100, 400 coupled to an inserter tool 1000.

The inserter tool 1000, as shown, includes the outer tube 1200, thehandle 1300 and the deployment knob 1500. The inner rod 1100 ispositioned within the outer tube 1200, and the outer tube is flush withthe anchor body 110, 410. The outer tube 1200 may hold the anchor body110, 410 steady during insertion and deployment. The inner rod 1100extends through the anchor body 110, 410 and couples with the expander180, 480 via threading. The expander 180, 480 is configured to beadvanced through the distal end of the anchor body 110, 410 by the innerrod 1100 via a rotating the deployment knob 1500.

In another embodiment, the inner rod 1100 extends through the expander180, 480. The inner rod 1100 is configured with a sharp, pointed tipsuch that the tip of the inner rod 1100 spears or captures tissue tosecure into the bone hole before the anchor body 110, 410 is fullydeployed.

The inner rod 1100 provides the mechanism to draw the expander 180, 480into the central bore 116, 416 in the anchor body 110, 410 to fullyexpand the anchor body 110, 410. During deployment of the tissue captureanchor 100, 400, the inner rod 1100 is continually advanced via ascrewing motion until the expander locks with the anchor body. As thedeployment knob 1500 continues to turn and the inner rod 1100 continuesto pull on the threads of the expander 180, 480, the inner rod 1100strips the threads from the inside of the expander 180, 480 and theinsertion tool 1000 releases from the anchor body 110, 410. Any threadshavings are contained within the outer tube 1200.

FIG. 18 illustrates an exploded view of the anchor 100 and the inserter1000. The tissue capture anchor 100 comprises the anchor body 110 andthe expander 180. The inserter tool 1000, as shown, includes the outertube 1200, the handle 1300 and the deployment knob 1500. The inner rod1100 is positioned within the outer tube 1200, and the outer tube isflush with the anchor body 110. The outer tube 1200 may hold the anchorbody 110 steady during insertion and deployment. The inner rod 1100extends through the anchor body 110 and couples with the expander 180via threading. The expander 180 is configured to be advanced through thedistal end of the anchor body 110 by the inner rod 1100 via a rotatingthe deployment knob 1500.

The inner rod 1100 provides the mechanism to draw the expander 180 intothe central hole 116 in the anchor body 110 to fully expand the anchorbody 110. During deployment of the tissue capture anchor 100, the innerrod 1100 is continually advanced via a screwing motion until theexpander locks with the anchor body. As the deployment knob 1500continues to turn and the inner rod 1100 continues to pull on thethreads of the expander 180, the inner rod 1100 strips the threads fromthe inside of the expander 180 and the insertion tool 1000 releases fromthe anchor body 110. Any thread shavings are contained within the outertube 1200.

In some embodiments, a pre-attached delivery handle is provided. In someembodiments, the insertion tool or delivery handle is disposable. Inother embodiments, the insertion tool can be sterilized, reloaded andreused.

Those of skill in the art will appreciate other inserters and mechanismsthat may be used to insert and deploy the dual expansion anchor 100, 400described herein.

Although a particular inserter device for inserting and manipulatingdual expansion anchor 100, 400 has been described, it should beunderstood that other inserter designs may be used for manipulating theparts of dual expansion anchor 100, 400 described above to insert theanchor into bone and tissue to the bone. For example, it may be possibleto use separate tools for inserting the anchor and deploying the anchor.

It will be appreciated that there are numerous combinations of anchorsand their placement that may be used to secure soft tissue to bone bythe methods and devices described herein. These variations as well asvariations in the design of the above described anchor devices andinserter devices are within the scope of the present disclosure.

Methods of Attaching Soft Tissue to Bone

Various embodiments include methods for attaching soft tissue to bone.In some embodiments, the methods include using the tissue captureanchors described above. In one preferred embodiment, a biceps tenodesisprocedure is performed arthroscopically.

The biceps tendon connects the biceps muscle to the bone. The bicepstendon connects the biceps muscle to the bone. The tendon passes fromthe muscle to the shoulder joint. Biceps tendon problems can also occurin conjunction with a rotator cuff tear.

A biceps tenodesis is a procedure that cuts the normal attachment of thebiceps tendon on the shoulder socket and reattaches the tendon to thebone of the humerus (arm bone). By performing a biceps tenodesis, thepressure of the biceps attachment is taken off the cartilage rim of theshoulder socket (the labrum), and a portion of the biceps tendon can besurgically removed. Essentially a biceps tenodesis moves the attachmentof the biceps tendon to a position that is out of the way of theshoulder joint.

A biceps tenodesis is often, but not always, performed in patients withsignificant biceps tendon symptoms, and evidence at the time of viewingof biceps tendon inflammation or tears.

The procedure using a tissue capture anchor described herein merelyrequires drilling the bone hole and capturing the tendon with the anchorand dragging the tendon into the bone hole. In some embodiments, afurther advantage when using an awl to make the bone hole is that thewhole procedure can be percutaneous.

In one method, the procedure is performed arthroscopically. In oneembodiment, the procedure is performed non-arthroscopically. In oneembodiment, for example, a percutaneous approach may be used. In oneembodiment, a 6 mm anchor is used, although different sizes andmaterials may be used. In some instances the hole into which the tissuecapture anchor will be inserted is made by making a clearance hole forthe anchor in the superior portion of the bicipital groove 1700, asshown in FIG. 19, using a drill bit or suitably sized awl. The hole mayalso be made in any other suitable position depending on pathology ofthe tendon, etc. FIGS. 19 and 20 show different views of the bicipitalgroove and surrounding bone of the shoulder and biceps. The bicipitalgroove is a furrow on the upper part of the humerus occupied by the longhead of the biceps and is also called the intertubercular groove. Insome embodiments a 7 mm drill bit is used; however in other embodiments,a different sized drill bit can be used. In one embodiment, theclearance hole can range from 5 mm wide to 9 mm wide, from 6.5 mm to 8mm wide, or any other desired range. In other embodiments, the size ofthe clearance hole will vary, as the size depends on the size of theanchor. Depending on the softness of the bone and the size of theanchor, the hole can be from 8 mm-40 mm deep, approximately 21 mm deep,approximately 30 mm deep, or any other desired depth. For example, inone embodiment, a 6 mm tissue capture anchor is used, and for soft bone,the hole can be at least 11 mm deep. For average bone, the hole can beapproximately 10-12 mm deep. For very soft bone, the hole can beapproximately 20 mm.

The implantation site is cleared of any soft tissue in the region of thebone hole using a bur or other suitable means. Angled protrusions orteeth may be used that provide greater resistance to removal of theanchor body 110, 410 than to insertion. As shown in FIG. 21, the tendonwill then be captured by the anchor and forced into the clearance holeand the anchor deployed as shown in FIG. 22. As shown in FIG. 23, thetendon is essentially folded around the anchor longitudinally resultingin a double surface contact. As described above, the tendon may becaptured using a variety of methods including those associated with thedifferent expander types of FIG. 7A.

In one nonlimiting embodiment, the shoulder preparation is as that usedby Richards and Brukhart (“A Biomechanical Analysis of Two BicepsTenodesis Fixation Techniques” Arthroscopy. The Journal OF Arthroscopicand Related Surgery Vol 21, No 7 (July), 2005:pp 861-866) which isincorporated by herein by reference in its entirety. The shoulder willundergo soft tissue dissection to the level of the rotator cuff. At thispoint, the surpraspinatus tendon insertion is reflected by sharpdissection and the long head biceps tendon inspected for any evidence ofpathology. The tendon of the LHB is then sharply incised, freeing fromits intra-articular origin at the superior aspect of the glenoid as wellas dividing it as the musculotendinous junction so that the bicepstendon is a free segment. In other embodiments, other methods ofshoulder preparation are used.

In some exemplary embodiments, repairs are complete by drilling aclearance hole for the anchor in the superior portion of the bicipitalgroove using a standard drill bit. As shown in FIGS. 21-23, the tendonwill then be captured by the anchor and forced in to the clearance holeand the anchor placed to capture the tendon. The tendon will beessentially folded around the anchor longitudinally, resulting in adouble surface contact. The proximal surface of the anchor will besituated flush with the cortical surface. In some embodiments, the holecan be located in other portions of the bone. In one exemplaryembodiment, the hole may be placed, approximately, 1 cm distal to theend of the bicipital groove.

In another embodiment, anchors as described above are used for anteriorcruciate ligament (ACL) repair. In this embodiment, a femoral tunnel isdrilled in the bone. One or two bundles of hamstring tendon are capturedby the anchor. The anchor is then inserted into the bone and deployed asdiscussed above. As described above, the tendon may be captured using avariety of methods including those associated with the differentexpander types of FIG. 7A.

In one embodiment, a hole is drilled in to the bone at a diameter ofabout 9 mm. The anchor is positioned such that a grasper tool can beimplemented to grasp a tendon secure the tendon. The tendon can then bemanipulated and moved or positioned. In one embodiment, a double bundleof tendons is inserted into a single bone tunnel in the femur. In oneembodiment, a gracilis and a semitendinosus tendon are both doubled overfor insertion into the bone hole. The anchor, which, in one embodimentmay be about 8 mm or 9 mm in diameter, is inserted into the bone holewith the doubled over tendons. Due to the size of the hole, the anchor,which may be 8 or 9 mm in diameter is inserted with the doubled overtendons draped over its tip into the hole. The anchor is also suited forsingle bundle single tunnel and single bundle double tunnel procedures.In other embodiments, the bone hole and the anchor can be differencesizes as needed.

In one embodiment, the surgeon drills through the tibia and up into thefemur and loads the anchor plus tendons through the tibial tunnel. Inone embodiment, an anteromedial portal is used to drill the femoraltunnel and a separate tibial tunnel.

It will be appreciated by those of skill in the art that the tissuecapture anchor 100, 400 and inserter tool 1000 provide a system for easyattachment of a tendon or tissue to bone. The anchor 100, 400 may beinserted into bone with minimal disruption of surrounding tissue. Onlyan access route having the diameter of the outer tube 1200 and theanchor body 110, 410 is required. Furthermore, the anchor can besecurely attached to the bone without having to insert additionalinstrumentation into the site or without performing any cumbersomeattachment maneuvers such as knot tying.

In another embodiment, anchors as described above are used for otherprocedures in the knee such as, for example, patellofemoral ligamentreconstruction, posterolateral corner reconstruction, and tibial anchorback-up for an ACL procedure.

In some embodiments, anchors as described above can be used for numeroustissue fixation procedures in foot and ankle. These include flexorhallucis longus transfer to Achilles for loss of Achilles mechanism;posterior tibial tendon to anterior midfoot (middle cuneiform) alsoknown as bridle/modified bridle procedure for foot drop; Lateralligament reconstruction with allograft (potentially as primary withBrostrom-Gould type procedure) for ankle instability or non-anatomiclateral ligament reconstruction using split peroneus brevis; deltoidligament reconstruction with allograft (for deltoid insufficiency);flexor digitorum longus or flexor hallucis longus transfer to peronealfor non-reconstructable peroneal tendon tears and reconstruction of torntibialis anterior with extensor hallucis longus tendon transfer.

Although the invention has been described with reference to embodimentsand examples, it should be understood that numerous and variousmodifications can be made without departing from the spirit of theinvention. Accordingly, the invention is limited only by the followingclaims.

What is claimed is:
 1. A bone anchor, comprising: a bone engaging memberhaving a first end and a second end, the bone engaging membercomprising: a first plurality of bone-engaging tines extendinglongitudinally towards the first end; a second plurality ofbone-engaging tines extending longitudinally towards the second end; anexpander comprising a first portion and a second portion positionedalong a longitudinal axis; wherein the expander is positioned betweenthe first plurality of bone engaging tines when the expander is in afirst position, wherein the expander is positioned between the firstplurality of bone engaging tines and between the second plurality ofbone engaging tines when the expander is in a second position; andwherein the expander is configured to expand both the first plurality ofof tines and the second plurality of of tines outward upon movement ofthe expander relative to the bone-engaging member from a first positionto a second position.
 2. The bone anchor of claim 1, wherein the firstplurality of bone engaging tines are equiangularly positioned around alongitudinal axis of the bone engaging member.
 3. The bone anchor ofclaim 1, wherein the second plurality of bone engaging tines areequiangularly positioned around a longitudinal axis of the bone engagingmember.
 4. The bone anchor of claim 1, wherein the first portion of theexpander is configured to radially expand the first plurality of oftines when the expander is moved from a first position to a secondposition.
 5. The bone anchor of claim 1, wherein the second portion ofthe expander is configured to radially expand the second plurality of oftines when the expander is moved from a first position to a secondposition.
 6. The bone anchor of claim 1, wherein the expander isconfigured to expand both the first plurality of of tines and the secondplurality of of tines outward upon the proximal movement of theexpander.